<!DOCTYPE HTML>
<html>
    <head>
        <meta http-equiv=Content-Type content="text/html;charset=utf-8" />
        <title>申请资料填写 - {$settings.shopname}</title>
        <meta name="viewport" content="width=device-width,initial-scale=1.0,maximum-scale=1.0,user-scalable=0" />
        <meta name="format-detection" content="telephone=no">
        <link href="{$docroot}static/css/wshop_companyreg.css?v={$cssversion}" type="text/css" rel="Stylesheet" />
        <link href="{$docroot}static/css/weui/weui.css?v={$cssversion}" type="text/css" rel="Stylesheet" />
        <script type="text/javascript" src="{$docroot}static/script/jquery-2.1.1.min.js?v={$cssversion}"></script>
        <script type="text/javascript" src="{$docroot}static/script/main.js?v={$cssversion}"></script>
        <script type="text/javascript" charset="utf-8" src="{$docroot}static/script/lib/validation/dist/jquery.validate.js"></script>
        <script type="text/javascript" charset="utf-8" src="{$docroot}static/script/lib/validation/dist/lang-cn.js"></script>
    </head>
    <body>        
        <input type="hidden" value="{$smarty.server.HTTP_REFERER}" id="referer" />
        <input type='hidden' value='{$openid}' id='openid' />
        <input type='hidden' value='{$head}' id='head' />
        <input type='hidden' value='{$sex}' id='sex' />
        
        <header class="bheader" id='comHead' style=''><span>代理申请</span></header>
        
        <!-- from -->
        <form id="login-wrap">
        <div class="weui_cells weui_cells_form">
            
            <div class="weui_cell">
                <div class="weui_cell_hd">
                    <label class="weui_label">手机号</label>
                </div>
                <div class="weui_cell_bd weui_cell_primary">
                    <input class="weui_input" type="tel" id="set-form-phone" tabindex="1"" placeholder="请输入手机号">
                </div>
            </div>
            
            <div class="weui_cell">
                <div class="weui_cell_hd">
                    <label class="weui_label">真实姓名</label>
                </div>
                <div class="weui_cell_bd weui_cell_primary">
                    <input class="weui_input" id="set-form-name" tabindex="2" placeholder="真实姓名">
                </div>
            </div>

            <div class="weui_cell">
                <div class="weui_cell_hd">
                    <label class="weui_label">电子邮箱</label>
                </div>
                <div class="weui_cell_bd weui_cell_primary">
                    <input class="weui_input" id="set-form-email" tabindex="2" placeholder="电子邮箱">
                </div>
            </div>
            
            <div class="weui_cell">
                <div class="weui_cell_hd">
                    <label class="weui_label">身份证号</label>
                </div>
                <div class="weui_cell_bd weui_cell_primary">
                    <input class="weui_input" id="set-form-id" tabindex="2" placeholder="身份证号">
                </div>
            </div>
        </div>
        </form>
        <div class="weui_btn_area">
            <a class="weui_btn weui_btn_primary" href="javascript:;" id="reg-btn">提交申请</a>
        </div>
        {include file="../../global/copyright.tpl"}
        <script type="text/javascript">
            WeixinJSBridgeReady(ComRegLoad);
        </script>
    </body>
</html>